Senate committee asks how it can HELP improve mental health care

The Senate Health, Education, Labor, and Pensions (HELP) Committee recently heard testimony from three federal officials as they considered pending and potential bills to increase the public understanding of mental illness and expand access to mental health services. Kana Enomoto, Acting Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), Dr. Thomas Insel, outgoing Director of the National Institute of Mental Health (NIMH), and James Macrae, Acting Administrator of the Health Resources and Services Administration (HRSA), each described the roles of their agencies in the study of mental health issues and promotion of access to mental health services.

There appeared to be consensus among the witnesses and the committee that:

about one American in five suffers from a mental illness in any given year;

the most serious chronic mental illnesses usually begin between the ages of 15 and 34;

there is a shortage of psychiatrists, psychologists, and other mental health professionals, especially in rural areas;

many patients suffer for months or years without treatment, in part because of the stigma attached to mental illness;

each of the agencies cooperates with the others to develop knowledge and expand access to services; and

it is necessary to build on existing legislation that guarantees parity of coverage for mental health and substance abuse to coverage for physical illness or injury.

ACA funding. Enomoto noted that the Patient Protection and Affordable Care Act (ACA) strengthened parity laws when it included mental health and substance use treatment among the essential health benefits that section 1302 every plan must carry. Macrae noted that ACA grants to build the health care work force, combined with other funding, have helped to quadruple the number of mental health professionals in the National Health Service Corps and to double the number at community mental health centers.

Pending legislation. Several members of the committee are sponsoring legislation focusing on mental health or mental illness. Specifically, Lamar Alexander (R-Tenn), Chair of the Committee, Ranking Member Patty Murray (D-Wash), and several other committee members are sponsoring S. 1893, The Mental Health Awareness and Improvement Act, which focuses on suicide prevention, particularly among groups that are at high risk for suicide. This legislation has been reported out of the HELP Committee to be placed on the Senate calendar.

Senators Chris Murphy (D-Conn) and Bill Cassidy (R-La), who also are members of the committee, introduced the Mental Health Reform Act of 2015 (S 1945), which would create the position of Assistant Secretary of Mental Health and Substance Use Disorders and Bureau of Mental Health Policy to marshal resources and direct them to finding and disseminating evidence-based practices, including programs that focus on early childhood intervention and treatment. Senator Murphy, a physician, called attention to the prevalence of early death and lost productivity.

Senator Murphy also questioned Enomoto about the alleged lack of activity of SAMHSA in fulfilling its role or coordinating interagency efforts on mental health, citing a GAO report that found the interagency steering committee had not met since 2009. Enomoto could not explain why the interagency mental health steering committee had not met, though she said other subcommittees were addressing its functions.

In response to questions from Senator Elizabeth Warren (D-Mass), Dr. Insel told the committee that the language prohibiting the use of certain federal funds for research on guns as a public health problem has not prevented the NIMH from pursuing research on the social determinants of violence or on consideration of access to guns in assessing an individual’s risk for suicide.